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Monitor restraint abuses to avoid false claims accusations

Health Care Auditing Strategies, June 1, 2005

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Patients have the right to be free from medically unnecessary restraints, or those administered by staff as a means for coercion, discipline, convenience, or retaliation. Otherwise, your facility may run into trouble under the False Claims Act.

That's according to Associate U.S. Attorney James G. Sheehan, who works in the Philadelphia U.S. Attorney's Office. Sheehan warned auditors and compliance officers during the Health Care Compliance Association's 2005 Compliance Institute in New Orleans in April to watch for restraint and other patients' rights abuses. In addition to jeopardizing your facility's accreditation, poor quality of care can also lead to noncompliance because the government considers claims for substandard care to be fraud.

"This is an issue that's coming up on the agenda," he said of patients' rights abuses. "It's a significant issue. If you just focus on compliance as a billing issue, you're missing the point. You want to focus on not just billing issues but on dignity, safety issues, and quality."

Sheehan is not the first to tell auditors and compliance officers to monitor patient restraints. The 2005 OIG Work Plan also states that the OIG will "assess hospital compliance with Medicare Conditions of Participation [ COP ] . . . which require hospitals to report [to CMS] all patient deaths that may have been caused by restraints or seclusion."

This is an excerpt from a member only article. To read the article in its entirety, please login.

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